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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Smoking During Pregnancy.

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Strategy. Adapted Healthcare (Pregnancy)

Approach. Support the development of multi-language educational materials about secondhand smoke exposure risk

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Overview. Adapted health care tailors care to patients' norms, beliefs, values, language, and literacy skills and may delve more deeply into social, psychological, and economic considerations.[1,2] Adapted care can include matching specialists to patients by background.[3] It may also involve adapting patient materials to reflect patients' background, place of origin, language, or literacy skills;[1] offering education via community-based health supporters;[4] or incorporating norms about faith, food, family, or self-image into patient care and implementing patient involvement strategies.[5]

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective...

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source.

Potential Data Sources. Data to support this strategy can be accessed through:

  • Documentation of material development processes
  • Reach and distribution data of materials
  • Feedback from target audiences and partners

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Health and Health Behaviors/Behavior Change. This strategy improves individuals' physical and mental health and their adoption of healthy behaviors (e.g., healthy eating, physical activity).
  • Health Care Access for All MCH Populations.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Health Teaching (Education and Promotion) (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy or aligned components.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the RBA framework (see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort (“What/how much did we do?”)

  • Number of community partners engaged in developing multi-language secondhand smoke education materials. (Measures collaborative approach)
  • Number of unique educational materials created in languages other than English to address secondhand smoke risks. (Measures reach of resources)

Quadrant 2:
Measuring Quality of Effort (“How well did we do it?”)

  • Percent of educational material development team members who share a similar background of the intended audience. (Measures representation)
  • Percent of secondhand smoke education materials assessed for appropriate reading level and health literacy standards. (Measures usability of content)

Quadrant 3:
Measuring Quantity of Effect (“Is anyone better off?”)

  • Number of pregnant women who strongly agree that the educational materials are relatable to their personal experiences. (Measures practical experience relevance)
  • Number of pregnant women reporting increased knowledge about secondhand smoke risks after receiving the adapted materials. (Measures impact on health literacy)
  • Number of households that institute a smoke-free home policy after receiving tailored education. (Measures behavior change impact)
  • Number of partners of pregnant women who seek cessation support after learning about secondhand smoke risks from the materials. (Measures broader impact on family health)

Quadrant 4:
Measuring Quality of Effect (“How are they better off?”)

  • Percent of educational material dissemination focused on neighborhoods with high rates of secondhand smoke exposure during pregnancy that results in an increase in knowledge and/or skill. (Measures tailored outreach to areas facing higher health risks)
  • Percent of community health workers trained to deliver the secondhand smoke education that results in an increase in knowledge and/or skill. (Measures workforce capacity)
  • Percent reduction in secondhand smoke exposure among pregnant women from groups with high exposure rates who receive tailored education. (Measures impact on reducing gaps)
  • Percent of pregnant women experiencing economic challenges who feel more confident in supporting a smoke-free environment after receiving the adapted materials. (Measures empowerment in focus populations)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Pottie 2013 - Pottie K, Hadi A, Chen J, Welch V, Hawthorne K. Realist review to understand the efficacy of culturally appropriate diabetes education programmes. Diabetic Medicine. 2013;30(9):1017-25.

2 Hodge 2010 - Hodge DR, Jackson KF, Vaughn MG. Culturally sensitive interventions and health and behavioral health youth outcomes: A meta-analytic review. Social Work in Health Care. 2010;49(5):401-23.

3 Chowdhary 2014 - Chowdhary N, Jotheeswaran AT, Nadkarni A, et al. The methods and outcomes of cultural adaptations of psychological treatments for depressive disorders: A systematic review. Psychological Medicine. 2014;44(6):1131-46.

4 Cochrane-Attridge 2014 - Attridge M, Creamer J, Ramsden M, Hawthorne K. Culturally appropriate health education for people in ethnic minority groups with type 2 diabetes mellitus: Review. The Cochrane Database of Systematic Reviews. 2014;(9):CD006424.

5 Kong 2014 - Kong A, Tussing-Humphreys LM, Odoms-Young AM, Stolley MR, Fitzgibbon ML. Systematic review of behavioural interventions with culturally adapted strategies to improve diet and weight outcomes in African American women. Obesity Reviews. 2014;15(S4):62-92.

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.